Spinal Cord Protection for Open Descending Thoracic and Thoracoabdominal Aorta Surgery: Analysis of The Society of Thoracic Surgeons Adult Cardiac Surgery Database

Spinal cord injury (SCI) is a devastating complication of open descending thoracic (DTAA) and thoracoabdominal aortic aneurysms (TAAA). We evaluated the efficacy of spinal drain placement on spinal injury in DTAA/TAAA repair.

Adult patients (≥18 years) undergoing open DTAA/TAAA repair without aortic root, ascending, or arch involvement were identified from The Society of Thoracic Surgeons Adult Cardiac Surgery Database (2017-2023). Patients with preoperative paralysis, postoperative spinal drain placement, or who died in the operating theater were excluded. Primary SCI outcomes were (1) lower extremity paralysis lasting >24 hours, and (2) a composite of paralysis and/or paresis lasting >24 hours. Multivariable logistic regression models with adjustment for patient, intraoperative, and aortic disease factors were derived to evaluate the role of spinal drain placement in DTAA and TAAA repair.

The study population included 2724 patients from 224 hospitals who underwent DTAA (n = 813; 61.3% spinal drain) or TAAA (n = 1911; 75.2% spinal drain) repairs. Observed rates of SCI were distinctly higher for TAAA than for DTAA repairs (paralysis: 7.3% vs 1.9%, P < .001; paralysis/paresis: 10.3% vs 3.0%; P < .001). Spinal drain was independently associated with increased paralysis (adjusted odds ratio, 3.63; 95% CI, 1.94-6.80; P < .001) and paralysis/paresis (adjusted odds ratio, 2.51; 95% CI, 1.58-4.00; P < .001) in TAAA repair but not DTAA.

An unexpected association was found between spinal drain use and increased SCI. We hypothesize that spinal drain use may indicate higher-risk anatomy as opposed to being a causative factor of SCI.